Strengthening PBL through a discursive practices approach to case-writing

In many ways the task of physicians is to listen to stories and place them within larger social contexts. Problem-based learning (PBL) can potentially reinforce such a view of the physician's work. The conventional PBL case, however, largely replicates the medical record, which in turn, is restricted in its purview to biomedical concerns. The conventional case thus encourages an approach to clinical reasoning that insufficiently recognizes (1) the cross-cultural nature of all clinical encounters, (2) the central role of narrative, and (3) the political economic influences that contribute to disease and suffering in our world.

We suggest ways to modify the traditional medical curriculum to include the learning of cross-cultural health through appropriately written problem-based learning (PBL) cases. We discuss two cases to illustrate how PBL cases can incorporate dialogue between patients and physicians, demonstrate the narrative character of the medical encounter and examine the political economic contributors to disease production.

Fluency in language games other than that of biomedicine is required if students are to become more aware of the wider factors that contribute to suffering, and to be able to respond with compassion and understanding to that suffering. Our approach is a discursive practices approach to culture that emphasizes the emergent, participant-constructed qualities of social phenomena while also acknowledging large-scale social forces.